Nursing Elites

1. A two-year-old child has sustained an injury to the leg and refuses to walk. The nurse in the emergency department documents swelling of the lower affected leg. Which of the following does the nurse suspect is the cause of the child's symptoms?

• A. Possible fracture of the tibia.
• B. Bruising of the gastrocnemius muscle.
• C. Possible fracture of the radius.
• D. No anatomic injury, the child wants his mother to carry him.

Correct answer: A

Rationale: The child's refusal to walk, along with swelling of the lower leg, indicates a possible fracture, specifically of the tibia. Fractures can cause pain and swelling, leading to difficulty or refusal to bear weight on the affected limb. Choice B, bruising of the gastrocnemius muscle, would not typically result in the child refusing to walk. Choice C, a possible fracture of the radius, is less likely given the location of the swelling and the associated refusal to walk. Choice D, stating no anatomic injury and attributing the child's behavior to wanting to be carried by the mother, is incorrect as the physical findings suggest a potential fracture that needs to be evaluated further.

2. A patient who has a right-sided chest tube following a thoracotomy has continuous bubbling in the suction-control chamber of the collection device. Which action by the nurse is most appropriate?

• A. Document the presence of continuous bubbling.
• B. Notify the surgeon of a possible pneumothorax.
• C. Take no further action with the collection device.
• D. Adjust the dial on the wall regulator to decrease suction.

Correct answer: C

Rationale: Continuous bubbling in the suction-control chamber of the chest tube collection device is an expected finding and indicates that the suction control chamber is connected to suction. It does not necessarily indicate a large air leak, which would be detected in the water-seal chamber. There is no evidence to suggest a pneumothorax based solely on continuous bubbling in the suction-control chamber. Adjusting the suction level by changing the wall regulator setting is not indicated in this situation, as the amount of suction applied is primarily regulated by the water level in the water-seal chamber and not by the vacuum source. Therefore, the most appropriate action in this scenario is for the nurse to take no further action with the collection device.

3. What should the nurse in the emergency department do first for a new patient who is vomiting blood?

• A. Insert a large-gauge IV catheter.
• B. Draw blood for coagulation studies.
• C. Check blood pressure (BP), heart rate, and respirations.
• D. Place the patient in the supine position.

Correct answer: C

Rationale: The nurse's initial action should focus on assessing the patient's hemodynamic status by checking vital signs like blood pressure, heart rate, and respirations. This assessment will help determine the patient's immediate needs and guide further interventions. Drawing blood for coagulation studies and inserting an IV catheter are important steps, but they can follow the initial assessment of vital signs. Placing the patient in the supine position can be risky without first assessing the patient's vital signs, as aspiration is a concern. Therefore, assessing vital signs is the priority to ensure appropriate and timely care for the patient.

4. A patient is admitted with active tuberculosis (TB). The nurse should question a healthcare provider's order to discontinue airborne precautions unless which assessment finding is documented?

• A. Chest x-ray shows no upper lobe infiltrates.
• B. TB medications have been taken for 6 months.
• C. Mantoux testing shows an induration of 10 mm.
• D. Three sputum smears for acid-fast bacilli are negative.

Correct answer: D

Rationale: The correct answer is D: Three sputum smears for acid-fast bacilli are negative. Negative sputum smears indicate that Mycobacterium tuberculosis is not present in the sputum, and the patient cannot transmit the bacteria by the airborne route. This finding is crucial for discontinuing airborne precautions. Choice A is incorrect because chest x-rays do not determine the presence of active TB for transmission precautions. Choice B is not directly related to the infectiousness of TB; completing a 6-month course of medication is important for treatment but does not confirm the absence of active disease or infectiousness. Choice C is not relevant to assessing infectiousness; Mantoux testing measures exposure to TB but does not confirm the absence of active infection or infectiousness.

5. The patient who has two fractured ribs from an automobile accident is receiving discharge teaching. Which statement by the patient indicates effective teaching?

• A. I am going to buy a rib binder to wear during the day.
• B. I can take shallow breaths to prevent my chest from hurting.
• C. I should plan on taking the pain pills only at bedtime so I can sleep.
• D. I will use the incentive spirometer every hour or two during the day.

Correct answer: D

Rationale: The correct answer is, 'I will use the incentive spirometer every hour or two during the day.' After sustaining rib fractures, it is crucial to prevent complications like atelectasis and pneumonia by practicing deep breathing and coughing. Using the incentive spirometer helps in maintaining lung expansion and preventing respiratory issues. Buying a rib binder could restrict chest expansion and hinder deep breathing efforts, increasing the risk of atelectasis. Taking shallow breaths may not effectively expand the lungs, leading to potential respiratory complications. Relying solely on pain medication at bedtime may not adequately address the need for lung expansion and prevention of respiratory complications during the day.

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